Kinematic Alignment Technique Outperforms Mechanical Alignment in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial.

BACKGROUND: The aim of this study was to compare the clinical results of kinematic alignment (KA) with those of mechanical alignment (MA) in single-stage bilateral total knee arthroplasty. METHODS: In this double-blinded randomized controlled trial, 65 patients who had bilateral knee osteoarthritis underwent simultaneous bilateral total knee arthroplasty. One knee was randomly selected to be operated on with the calipered-KA technique and the other with MA. The participants were assessed via the Oxford Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index questionnaire, and visual analog scale before the surgery and the same plus the Forgotten Joint Score at their last follow-up visit, 2 years postoperatively. Maximum knee flexion and the time reaching maximum knee flexion, named the recovery time, were also recorded. Hip-knee-ankle angle, medial proximal tibial angle, and lateral distal femoral angle were measured before and after the surgery using 3-joint-view radiographs. RESULTS: At 2 years, there were significant differences between the KA and MA techniques in terms of duration of surgery, recovery time, and final Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and maximum flexion range in favor of KA (P < .05), but no significant difference in visual analog scale score or Oxford Knee Score. In patients who have a preferred knee, the KA knee was preferred over the MA knee by most patients. No prosthetic failure or revision was reported in either group. CONCLUSIONS: The KA technique yields acceptable functional outcomes compared to the MA technique. The KA technique was associated with a shorter surgery time, a faster recovery time, and higher patient satisfaction in 2-year follow-ups. Larger multicenter studies with longer follow-ups are warranted to confirm these findings. LEVEL OF EVIDENCE: I.

Polymerase Chain Reaction Assay Using the Restriction Fragment Length Polymorphism Technique in the Detection of Prosthetic Joint Infections: A Multi-Centered Study.

BACKGROUND: PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) techniques have been used for the diagnosis of bacteria in some infections. In this study, we aimed to evaluate the diagnostic accuracy of PCR for the diagnosis of prosthetic joint infections (PJI) and to identify isolated microorganisms, using the RFLP method. METHODS: During January 2015 to January 2018, patients who were suspected of having PJI after arthroplasty surgery or were candidates for revision surgery due to loosening of implant entered the study. Patients who had 1 major criterion or 3 minor criteria for PJI based on the Philadelphia Consensus Criteria (PCC) on Periprosthetic Joint Infection were considered as cases of PJI. Both culture results and PCR findings, were cross compared with results of the PCC (as the gold standard criteria). RESULTS: Overall, 76 samples were included in the study. Mean (standard deviation) age of patients was 66.72 ± 11.82 years. Overall, 57.9% of patients were females. Prevalence of PJI was 50% based on the PCC. Sensitivity, specificity, positive predictive value, negative predictive value, and general efficacy of PCR for detection of PJI was 97.4%, 100%, 100%, 97.4%, and 98.7%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and general efficacy of culture was 31.6%, 100%, 65.7%, 100%, and 59.4%, respectively. We isolated a broad range of bacteria using PCR-RFLP including Gram-positive cocci such as Staphylococcus sp., Streptococcus sp., and Enterococcus sp., and Gram-negative bacilli such as Enterobacteriaceae sp., Pseudomonas sp. Citrobacter sp., as well as Chlamydophila pneumonia, Stenotrophomonas maltophilia, Brucella melitensis, non-gonococcal Neisseria, Kingella kingae, Bacteroides ovatus, and Proteus mirabilis from PJI patients. CONCLUSION: Inhere, for the first time, we showed that PCR-RFLP is a powerful tool for identifying the type of bacteria involved in PJI, and can be used for follow-up of patients suspected of PJI and those with a history of antibiotic use. PCR-RFLP may be able to substantially decrease detection time of PJI among PCR-based methods, while allowing more accurate identification of the bacteria involved.

Comparing efficacy of three methods of tranexamic acid administration in reducing hemoglobin drop following total knee arthroplasty.

The ideal method of providing tranexamic acid (TXA) for decreasing hemoglobin drop after TKA is still controversial. In this clinical trial, 200 patients were randomly allocated to four groups. In group 1,500 mg TXA was administered intravenously. In group 2, the joint irrigated with 3 g of TXA in 100 cc of saline. In group 3, 1.5 g of TXA was injected through the drain. Group 4 did not take TXA. Albeit all methods had a statistical effect on hemoglobin drop, drainage and number of transfused units when compared to controls, but intravenous injection of TXA seems to be much more effective in terms of reducing hemoglobin drop and transfused units; and what's more TXA injection by drain is more effective regarding to reducing postoperative drainage.

Reconstruction of the anterior cruciate ligament: a comparison between bone-patellar tendon-bone grafts and fourstrand hamstring grafts.

BACKGROUND: Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval. METHODS: Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTB autograft, and 41 were treated with ST autograft. At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC (International Knee Documentation Committee) score and complications. RESULTS: At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). The activity levels were higher in BPTB group (p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patients in BPTB and ST group, respectively (p=0.019). Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications. CONCLUSION: The results indicate a trend toward increased graft laxity and pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function.

Feasibility and acceptability of a telerehabilitation intervention on patients undergoing total knee arthroplasty in Iran: randomised controlled trial protocol.

INTRODUCTION: Telerehabilitation is a promising avenue to enhance post-total knee arthroplasty (TKA) rehabilitation by improving accessibility, convenience and cost-effectiveness. Despite its potential benefits, its application in the context of TKA in Iran is in its early stages, lacking comprehensive studies on feasibility, acceptance and programme adherence. This article outlines a protocol for an open-label, parallel-group, randomised controlled trial investigating the impact of a 4 week telerehabilitation programme alongside usual care. METHODS: Thirty patients (aged 50-90) undergoing TKA for severe Knee Osteoarthritis at Atiyeh Hospital in Tehran, Iran, will be recruited using block randomisation. Participants will be assigned to either the intervention group, receiving telerehabilitation or the control group without telerehabilitation. The intervention will include virtual physiotherapy sessions thrice weekly, lasting 30-45 min each, over 4 weeks. The primary objective is to assess the feasibility and acceptability of telerehabilitation, measured through recruitment and attrition rates, questionnaire completion rates, patient satisfaction using appropriate questionnaire and adherence to the intervention. Secondary outcomes encompass four Knee Injury and Osteoarthritis Outcome Score questionnaire subscales (function in Activities of Daily Living, Pain, Symptoms, Quality of Life). Patient global assessment will use a standardised question. An online survey will evaluate walking assistant device usage, exercise adherence and adverse events. The number of individuals receiving in-person rehabilitation will be documented after the first postoperative surgeon visit. Assessments occur at baseline and 4 weeks postsurgery. ANALYSIS: Statistical analysis, including independent samples t-test, paired samples t-test, χ2 test, Fisher's exact test, analysis of covariance and multiple linear regression, will use SPSS software version 16, with significance set at p<0.05. ETHICS AND DISSEMINATION: Approved by AJA University of Medical Sciences Ethics Committee (IR.AJAUMS.REC.1402.126), trial results will be presented to relevant groups and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: TCTR20231020004.

The Outcomes of Distraction Osteogenesis over an Intramedullary Nail for the Treatment of Bone Defects in Infectious Nonunions.

Objectives: The concurrent utilization of an external fixator and intramedullary nail (IMN) for segment transportation may potentially decrease the duration of external fixator implementation and reduce associated complications. This study aimed to report the outcomes of bone transport utilizing a combination of IMN and Ilizarov frame in a cohort of individuals who had tibia or femur critical-sized bone deficiency resulting from nonunion. Methods: The present research used a single-arm clinical trial design to enroll a series of patients presenting with critical-sized bone defects resulting from infectious nonunion of the tibia or femur. The study was conducted during the period of 2017-2020 in a referral Orthopedic Surgery Center located in Tehran, Iran. The management of patients with infectious nonunion was carried out through two main stages, including infection eradication and bone transportation. The process of bone healing and segment transportation was evaluated by radiographic assessment throughout the follow-up period. Results: A total of 39 patients with bone defects in the tibia (19 cases) or femur (20 cases) with a mean age of 31.44 (±11.95, range=18-60) were included in this study. Twenty-nine (74.3%) patients had open fractures. The bone defect exhibited an average size of 6.31 ± 1.95 cm. The mean of the consolidation index (CI) was 0.97 (range=0.51-1.32) mo/cm, and the mean of the external fixator index was 0.67 (range=0.41-1.10). Although the CI was longer in patients with open fracture compared to those with closed fracture, the difference was not statistically significant (P=0.353). After the end of the two-year follow-up, complete union was observed in 35 patients (89.7%). Conclusion: Intercalary segmental bone transportation using the Ilizarov technique over an IMN, as well as preserving the advantages of the conventional callotasis method, reduces the complications of long-term use of the Ilizarov frame and increases patient adherence to treatment.

A New Concept of Using Femoral Condyles Surface for Femoral Component Alignment During Total Knee Arthroplasty: A Technical Note.

Background: Orthopedic surgeons favor an intramedullary guiding system on the femoral component during total knee arthroplasty (TKA); nevertheless, improper positioning of the entry point affects the final alignment. We have designed a new femoral cutting system for TKA that uses the distal and posterior femoral condyles as reference points for the setting of the cutting system regardless of the femoral canal. This study aims to evaluate the outcomes of this new guiding system. Methods: We enrolled a series of 75 consecutive knees undergoing TKA. The alpha, gamma, and hip-knee-ankle (HKA) angles were assessed three months postoperatively. Also, surgical time and intraoperative blood loss were recorded for all patients. Results: Fifteen patients underwent TKA using the mechanical alignment (MA) strategy, and 60 underwent kinematically aligned (KA) TKA. Both groups showed normal coronal and sagittal alignment 3 months postoperatively. The mean intraoperative blood loss was 213.11 ± 52.73 ml, which was not different between the two groups (n.s.). The mean surgical time was 43.12 ± 11.62 min, which was significantly shorter in the KA-TKA (41.11 ± 3.77 min) than in the MA-TKA (49.34 ± 4.56 min) (P < 0.001). Conclusion: Using the new guiding system with good femoral alignment, we introduced the easily palpable and available condylar surface as a new landmark for cutting the distal femur in TKA. Level of Evidence: IV.

Is Posterior Cruciate Ligament Needle Pie-Crusting Safe and Effective in Balancing Cruciate-Retained Total Knee Arthroplasty? A Comparative Study.

Background: There is still debate over whether to sacrifice the posterior cruciate ligament (PCL) during total knee arthroplasty (TKA). Several studies reported the costs and benefits of each approach regarding technical difficulties in PCL balancing and postoperation complications. In this study, we aimed to evaluate PCL needling as a safe method for balancing the cruciate-retained TKA (CR-TKA). Methods: In this comparative study, 120 patients underwent CR-TKA and were divided into 2 groups. Fifty-four patients with an acceptable PCL tightness were included in group A, and 66 cases with a tight PCL were included in group B. In group B, needle pie-crusting of the PCL was performed instead of releasing the PCL from its insertions as the standard procedure. The participants' functional outcomes, pain severity, knee range of motion, and PCL laxity were evaluated during multiple follow-ups in 3 years postoperatively. Results: The participants' age, weight, and body mass index did not differ between the 2 groups. The mean age of the patients was 69 ± 5.9 years. The functional outcomes and range of motion of the patients in the 2 groups significantly improved after the operation compared to the preoperative status, but the postoperative score was not significantly different between groups (P > .05). Clinical examinations were normal in all patients in both groups in all follow-up stages. Conclusions: PCL balancing is a time-consuming yet essential step for the outcome of CR-TKA and patient satisfaction. PCL needling technique shows promising results and a few complications for PCL balancing in CR-TKA.

Evaluation of the Validity and Reliability of a Persian Version of the Forgotten Joint Score in Patients Undergoing Total Hip Arthroplasty.

Objectives: The increasing number of total hip arthroplasties (THA) has led to increased patient demands and expectations, making it crucial to assess patients' ability to "forget" their implants in daily life. This study aimed to determine the reliability and validity of a Persian version of the Forgotten Joint Score (P-FJS) in THA patients. Methods: The questionnaire was translated bidirectionally with the permission of the questionnaire designer. Data were collected from 2018 to 2020 and included 142 patients who had undergone THA by the same surgeon at least one year ago. Participants completed the FJS questionnaire twice within a one-week interval, and the validity, reliability, and feasibility of the questionnaires were assessed using statistical tests on the HHS and OHS forms completed by all participants. Results: In 142 patients (52.1% male) with a mean age of 65 ± 0.5 years who answered the questionnaires, P-FJS correlated strongly with OHS and HHS. The internal consistency (α = 0.91) and reproducibility of the questionnaire were excellent. None of the floor and ceiling effects were detected. Conclusion: The P-FJS questionnaire in the THA is considered a legitimate, repeatable, and self-administered survey that can be compared to its English-language counterpart. In addition, it is noteworthy that this version does not show any floor or ceiling effects.

Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer.

PURPOSE: The purpose of this study was to evaluate the outcomes following reconstruction of the chronic Achilles tendon ruptures with large gaps (>6 cm) using free semitendinosus tendon graft transfer. METHODS: There were 11 consecutive patients underwent the above-mentioned surgical technique for the treatment of chronically ruptured Achilles tendon contributed in current study and were followed up prospectively for a mean of 25 ± 3 months. The intraoperative tendon defect was greater than 6 cm in all of the patients. Functional and clinical assessment was performed using The American Orthopaedic Foot and Ankle Society (AOFAS) and Achilles Tendon Rupture Score (ATRS). RESULTS: The average AOFAS and ATRS improved significantly from 70 ± 5 and 32 ± 6 preoperatively, to 92 ± 5 and 89 ± 4 points post-operatively (P = 0.001). The range of dorsiflexion was significantly limited on the operated side (13 ± 4° vs. 17 ± 4°) (P = 0.04). All patients were able to stand on the tiptoe of injured leg, and no patient walked with a visible limp. Post-operative complications included one patient with symptomatic DVT and 2 patients with superficial infection treated nonoperatively. CONCLUSIONS: The technique offers good clinical and functional outcomes and is safe. Reconstruction of the chronic Achilles tendon ruptures with free semitendinosus tendon graft in patients with defects greater than 6 cm is recommended. LEVEL OF EVIDENCE: IV.

Osteogenic Differentiation Effect of BMP-9 with Phenamil and Simvastatin on Intact Human Amniotic Epithelial Stem Cells

Background: Background: Bone tissue engineering has shown to be a promising strategy for repairing bone defects without causing harmful side effects to the patient. Three main building blocks of tissue engineering, including seeding cells, scaffold, and signaling molecules, are required for adequate bone regeneration. The human amniotic membrane (hAM) is the innermost of the placental membranes. In addition to providing a source of stem cells and growth factors, hAM has several features that make it an appropriate scaffold containing stem cells for use in tissue engineering purposes. The present investigation aimed to assess the effect of bone morphogenetic protein-9 (BMP-9) combined with phenamil and simvastatin on osteogenic induction of hAM with its human amniotic membrane epithelial cells (hAECs). Method: Methods: Using six different osteogenic medium (OMs), we cultured hAM for 14 days. The basic OMs were chosen as the first group and other media were made by adding BMP-9, phenamil, simvastatin, BMP-9 alongside phenamil, and BMP-9 alongside simvastatin to the basic OMs. Finally, viability assay, tissue mineralization, calcium and phosphate content determination, and measurement of lactic acid dehydrogenase (LDH), and alkaline phosphatase (ALP) activity were performed. Results: Results: Among all study groups, groups containing simvastatin showed a significantly lower level of viability. Although all media could induce osteogenic features, the hAECs cultured in media containing BMP-9 and phenamil demonstrated a wider area of mineralization and a significantly higher level of calcium and phosphate content, LDH, and ALP activity. Conclusion: Conclusion: Our findings indicated that the use of phenamil together with BMP-9 could synergistically show in situ osteogenic induction in hAECs, which could be a new insight into translational medicine.

Recent advances on small molecules in osteogenic differentiation of stem cells and the underlying signaling pathways.

Bone-related diseases are major contributors to morbidity and mortality in elderly people and the current treatments result in insufficient healing and several complications. One of the promising areas of research for healing bone fractures and skeletal defects is regenerative medicine using stem cells. Differentiating stem cells using agents that shift cell development towards the preferred lineage requires activation of certain intracellular signaling pathways, many of which are known to induce osteogenesis during embryological stages. Imitating embryological bone formation through activation of these signaling pathways has been the focus of many osteogenic studies. Activation of osteogenic signaling can be done by using small molecules. Several of these agents, e.g., statins, metformin, adenosine, and dexamethasone have other clinical uses but have also shown osteogenic capacities. On the other hand, some other molecules such as T63 and tetrahydroquinolines are not as well recognized in the clinic. Osteogenic small molecules exert their effects through the activation of signaling pathways known to be related to osteogenesis. These pathways include more well-known pathways including BMP/Smad, Wnt, and Hedgehog as well as ancillary pathways including estrogen signaling and neuropeptide signaling. In this paper, we review the recent data on small molecule-mediated osteogenic differentiation, possible adjunctive agents with these molecules, and the signaling pathways through which each small molecule exerts its effects.

Fixed-Bearing Posterior-Stabilized Implant versus Constrained Condylar Knee in One-Stage Bilateral Primary Arthroplasty of the Varus Knee: A Randomized Controlled Trial with Minimum 2-year Follow-Up.

Background: Severe varus deformity of the knee poses a technical challenge in balancing the flexion-extension gaps. The use of a varus-valgus constrained prosthesis is a solution to achieve coronal plane stability. The results of constrained condylar knee (CCK) implants in primary total knee arthroplasty are not well known. This study aims to compare the functional outcomes of posterior-stabilized (PS) and CCK implants for primary arthroplasty of the varus knee. Materials and Methods: Twenty patients with bilateral severe osteoarthritis and genu varum of more than 10° were enrolled in this study. One knee was randomly implanted with a fixed-bearing PS implant, whereas the other was implanted with a CCK prosthesis. Pre- and postoperative Knee Society Score (KSS) and Oxford Knee Score (OKS) questionnaires were completed, and knee flexion was measured and compared. Results: The patients were followed for 32 months on average (24-36 months). On the KSS and OKS, both the groups improved significantly, but the difference between them was not statistically significant. Postoperative knee flexion was also not different between the two groups. Furthermore, 18 patients could not distinguish the difference between the two prostheses, whereas two patients preferred the PS one. Conclusion: We demonstrated that a PS prosthesis can achieve comparable functional results to the CCK one in the short term.

Candida albicans Prosthetic Joint Infection After Total Knee Arthroplasty: A Rare Case Report.

In this article, a 75-year-old patient with pain in left knee and restricted range of motion following total knee arthroplasty (TKA) is presented. Serological evaluation and aspiration of knee joint suggested a fungal prosthetic joint infection. After the diagnosis was confirmed, treatment started with antifungal drugs, removing prosthesis, exhaustive debridement, and revision of TKA after efficient antifungal treatment. At one-year follow-up, she has a painless motion range of 10 to 90 degrees, and there was no recurrence of infection observed.

Outcomes of Tibial Plateau Fracture Surgical Fixation: a Comparative Study between Younger and Older Age Groups.

BACKGROUND: Tibial plateau fractures account for approximately 8% of the fractures of the elderly. Low bone quality that is more common in the elderly is one of the major challenges in fixing fractures and may be a barrier to achieving satisfactory outcomes after a surgical fracture treatment. Accordingly, surgical fixation of tibial plateau fractures was controversial in the elderly. This study aimed to investigate and compare the clinical outcomes of surgical fixation in patients over and under 60 years of age. METHODS: This study was conducted as a retrospective cohort study of data that were prospectively collected. In total, 48 patients who underwent surgery with open reduction and internal fixation before August 2019 were recruited and followed up at least one year after surgery. Demographic characteristics, the range of motion of the knees, visual analog scale (VAS) score of pain intensity, and the Oxford Knee Score (OKS) were obtained in this study. Furthermore, Short Form-36 (SF-36) questionnaire was used to evaluate patient satisfaction. RESULTS: In total, 19 and 29 patients were over and under 60 years of age, respectively. According to Schatzker's classification, the most common type of fracture was type VI. The range of motion in the knees did not differ significantly between the two groups (P>0.05). Moreover, OKS and the VAS of pain intensity were not significantly different in both groups (P>0.05). In addition, SF-36 scores were not significantly different between elderly patients and the age-matched general population. However, younger patients had lower scores in the physical function and vitality scales of SF-36, compared to the age-matched general population. CONCLUSION: Based on the results of the present study, it can be stated that increasing age did not affect the surgical outcomes of patients with tibial plateau fractures.

Clinical Outcome Comparison between Staged -Bilateral Versus Simultaneous Bilateral Total Knee Replacements.

BACKGROUND: This retrospective study aimed to compare the clinical outcomes of patients with staged and simultaneous bilateral total knee arthroplasty (TKA). METHODS: The present study included 100 patients with a mean age of 62±3.72 years from 2014 to 2017. Among them, 51 and 49 patients underwent simultaneous and staged bilateral TKA, respectively. The two groups were compared regarding the range of motion (ROM), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improvement, and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores. The mean follow-up duration was 24 months (range: 12-36 months). RESULTS: According to the results obtained from the SF-36 questionnaire (possessing eight different factors of quality of life), there was no significant difference between the two groups. Furthermore, the OKSs were 39.98±1.52 and 38.68±2.55 in the simultaneous and staged groups, respectively. Moreover, the WOMAC improvement scores were obtained at 84.15±2.2 and 83.26±2.6 in the simultaneous and staged groups, respectively. The final knee ROM was acceptable without a significant difference between the two groups. CONCLUSION: Substantial controversy about the complications, functional, and clinical outcomes has negatively affected the decision of the surgeons on conducting bilateral sequential TKA. This clinical assessment revealed that all determinants, including OKS, WOMAC, SF-36, ROM, postoperative bleeding, and hospitalization duration exhibited almost the same improvement in both groups. According to this study, no statistically significant difference exists in both procedures.

A Modified Technique for Artificial Fusion in Unreconstructable Revision Total Knee Arthroplasty.

Knee arthrodesis is an acceptable treatment that leads to a stable joint with a lower rate of recurrence of infection in periprosthetic joint infections. One of the major problems in some revision cases is the bone loss that interferes with the bony union; therefore, some studies suggest artificial arthrodesis, which does not require bony union. The present descriptive retrospective study was conducted by reviewing the medical records of patients with periprosthetic joint infection complications. Patient satisfaction was evaluated after artificial arthrodesis, based on the visualized analog scale score and Oxford Knee Score. The mean Oxford Knee Score was 28, and the mean limb length discrepancy was 11 mm. In this new method, the length of hospitalization and leg length discrepancy was reduced, limb alignment and rotation was adjustable, and periprosthetic joint infection was controlled in nearly all patients.

Modified patellar side harvest technique for bone-patella, tendon-bone autograft anterior cruciate ligament reconstruction; a three-year prospective cohort.

PURPOSE: To introduce and discuss the outcome of a modified patellar side harvest technique. METHODS: This prospective cohort was conducted on patients with torn ACL who were eligible candidates for surgical intervention. Demographics and baseline characteristics were gathered for each patient. RESULTS: In total, 1024 patients with a mean age of 30.6 ±â€¯3.6 were enrolled in this cohort. Results of modified IKDC scores reported with good and excellent outcome in 75% of patients. CONCLUSION: Most of the patients who underwent BPTB-ACL reconstruction surgery with modified patellar side harvest technique, experienced acceptable clinical outcome.

Closed K-wire Fixation for the Treatment of Perilunate Dislocation and Trans-Scaphoid Perilunate Fracture Dislocations without Ligamentous Repair: Short Term Follow-Up.

BACKGROUND: The purpose of this study was to evaluate the treatment outcomes of perilunate dislocations (PLDs) and transscaphoid perilunate fracture dislocations (TSPLDs) treated with operative volar approach without ligament repair or reconstruction. METHODS: A total of seven patients (10 hands) were studied during 2017-2018. We fixed scaphoid fractures thorough a volar approach and 3 k-wires were inserted to stabilize the scaphoid to the adjacent bones. We evaluated patients' range of motion by VAS and grip strength, sensitivity assessment, and radiographs. Mayo and DASH scores were also recorded for wrist evaluation. RESULTS: All fractures united well. The mean Mayo wrist score was 81.5. Five patients scored good and excellent results (90-100). Excellent DASH scores (˂20) were observed in 4 patients and there was no poor DASH score (˃50). CONCLUSION: Treatment of PLDs and TSPLDs with k-wire and screw fixation using a volar approach and without any ligament repair or reconstruction results in minimal manipulation and has favorable short-term outcomes.